Forget about the cratered launch of ObamaCare. There is one sign of life still among the rubble. That sign of life is the free market.

There are any number of new companies that have sprung up to take advantage of gaps in the sprawling new law.

Extend Health, Inc. is a start-up that launched one of the first private insurance exchanges. Last year it was sold for nearly a half billion dollars.

How about Castlight Health? Their products put the transparency back into healthcare costs so consumers and employers can make more informed decisions about their costs and healthcare utilization.

And there’s Benefitter, Inc., whose software and support products help employers and their workers navigate the murky waters of Affordable Care Act regulations.

All of these entrepreneurs share one thing: They saw a big change coming and decided to manageit, rather than being managed by it.

At Chaddsford Planning Associates we’ve been part of a similar phenomenon. In the 1990s, President Bill Clinton pledged to “end welfare as we know it.” 

The cry against welfare reform, passed by Congress in 1996, was not unlike what we’ve seen with the Affordable Care Act. Each was a radical re-working of the social safety net.

I launched Chaddsford Planning the following year to take advantage of the fact that states, recipients and the private sector were facing a compliance issue with very little in the way of support.

Our first client was a trade association representing the food retailing industry. That was followed by another lobbying group representing the financial industry. Then came a major transaction processor. And a group of states. Then more states. And an equipment manufacturer. Then a company from France wanting to take advantage of its experience supplying product to that country’s social safety net. And then an Asian company wanting to sell to Hispanic Americans. And on and on.

The business environment changes all the time. If you’re a business you either take advantage of that, or be taken advantage of. That transaction processor? We helped develop two products that threw off $25 million in the first six months. The equipment manufacturer? A contract for 10,000 units within the first four months.

During the past 16 years we’ve helped more than 30 states plan for the adoption of electronic payment technology to replace their outdated paper benefit payment systems. All part of modernizing how we delivery social benefits. 

The next time change hits your business, tackle the problems it creates,  but don't stop there. Look for the opportunities that change can create for you.

As for the Affordable Care Act, who would have thought that a law, which at its core essentially converts one-sixth of the U.S. economy into a public utility, could rile up the animal instincts of the free market?

Welcome to America!

Consultants get a bad rap. Sometimes deservedly so. I thought about this recently amid the revelations of the government’s failed www.healthcare.gov website. It appears that rather than hire a consultant to manage the development of the site, the Department of Health and Human Services allowed one of its own agencies to oversee the development and testing of the website.

This is not a rip-on-ObamaCare riff. But it is about what happens when a technology project goes awry. And it’s about whether you should hire a consultant and when it makes sense to do so.

Here are just three examples of when hiring an outside consultant makes sense. First, hiring a consultant makes sense if you have a lack of staff time to allocate to your project. I know of few organizations that have time on their hands. Bringing in a consultant makes sense if you have a one-off project and not enough time. If you have a continuing project it makes sense to hire your own staff.

A second reason to hire a consultant is if you or your staff lacks the expertise to get the job done. This takes some soul-searching on your part. But be honest. Who has the time or inclination to do everything? If you’re a technology-driven company and you need a sales portfolio prepared, it makes sense to go to a sales consultant.

A third reason to hire a consultant is to put “another set of eyeballs” on the problem. In business we often spend so much time on a project that we develop what I call a proprietary interest in it. We built it; we own it. Having employees invested in a project is good. However, being so invested that you can’t see the flaws in your baby isn’t so good. A consultant can come in and give you an honest appraisal of where you are in the project and how to bring it in for a landing.

These are basically the three reasons people hire us. There are others, but most of our calls come when nobody on board has the time or the expertise, or the objectivity to bring a business development project to conclusion.

For example, for several years we were retained by a think tank called the Center for Health Transformation. CHT was at the time a think tank based in Washington, that provided thought leadership on how to use healthcare technology to improve the quality and lower the price of healthcare.

Our job was to interview and report on notable uses of cutting edge technology in the healthcare industry, including accountable-care organizations, health information exchanges and healthcare analytics. Our job was to produce a series of white papers on health IT for the client.

CHT didn’t hire us because of a lack of expertise. There were more health IT policy experts in their hallways than the hallways of Congress.

But CHT lacked one thing: time. In the fast-paced DC environment they lacked the time to methodically dig out the necessary information and produce attractive crying-to-be-read white papers. That’s what we did, bringing the objective eye of a reporter and the sharp pencil of an editor to the job.

Some of those white papers are available for viewing on this site.

Not all jobs have the crushing deadlines, technical complexity and inbred proprietary design require a consultant. But a lot do. (DHHS, are you still reading?)

So here’s some free advice from the consultants: If your job is in that category, stop going around in circles and start looking for help.

Now start the meter.

There is a new healthcare product on the market in Michigan and it could end up saving consumers thousands of dollars, according to the vendor. And it’s almost deceptively simple in its design.

The Healthcare Blue Book aims to do for healthcare what the Kelley Blue Book did for used car shopping: allow you to compare prices before you buy. The Healthcare Blue Book identifies the prices of more than 200 medical procedures—from surgeries to imaging tests. So says the product’s vendor, Priority Health.

Priority Healthis a non-profit health plan in Michigan. Their Blue Book uses Priority Health’s contracted provider fees to figure out what Priority calls a “fair price” for healthcare services. The product evaluates prices throughout Michigan based on whether they are fair, more expensive than fair, or below the fair benchmark.

Like it or not, we’re all consumers of healthcare. The older we get, the more we consume. One of the reasons we’ve let healthcare get so expensive is that we’re not savvy shoppers.  There’s no reason shopping for healthcare should be any different than shopping for a car.

Until the late 1950s buying a new car was a mystery to most people. A buyer had no clue what the car cost to make, what the manufacturer’s markup was, and how much the dealer made. A buyer was just guessing when he negotiated with the dealer, who held all the cards.

In 1958 Oklahoma Senator Mike Monroneysponsored the Automobile Information Disclosure Act of 1958.  The law required car manufacturers to post the suggested retail price of the car on the vehicle. It was a start. Consumers could at least know what the manufacturer thought the car was worth. Salesmen in bad suits and loud ties could no long lard up the price with secret dealer markups.

Eight years later a publisher named Edmund’s began publishing quarterly guides with car purchasing information: list price, markup, cost of options and other data. If you knew about Edmund’s you could negotiate a fairer price because the dealer was no longer the only one at the table who knew what things actually cost.

In the mid-1990s, Edmund’s took its information to the Internet and forever changed the way people buy and sell new cars. Now both parties—buyer and seller—had the same data. Car buying became less about pulling the wool over buyers’ eyes and more about working professionally with buyers to find the right car at the right price.

Products like the Healthcare Blue Book have the potential to shine a light in the dark recesses of healthcare—the Finance Department—much like Sen. Monroney and Edmund’s did for buying a new car.

In a technology-driven world we often want the Big Solution. The sexiest, most technical, most awe-inspiring solution to a problem. It’s that way with healthcare. I don’t think that health information exchanges, ACA, ACOs, HIEs or any other alphabet soup solutions will necessarily get us to the level of healthcare reform we need.

I think that small, incremental, common-sense steps like establishing pricing transparency with products like the Healthcare Blue Book, restoring cuts to tax-free savings for medical expenses, making insurance truly portable from job to job, medical liability reform, health savings accounts, and selling insurance across state lines to increase competition have to be part of any solution.

As I tell my kids, take care of the little things. If you do that the big things usually take care of themselves.

Last week 13 attorneys general sent a letterto Health and Human Services Secretary Kathleen Sebelius expressing privacy concerns over the Affordable Care Act. 

Their specific concern is the enrollment procedures for the health insurance exchanges (HIX) being planned under the law. The AGs told the Secretary that the people who take your personal health information when you enroll in an HIX aren’t adequately trained in how to handle it.

I should add that the 13 AGs represent states that have declined to establish their own state exchanges.

Last month DHHS released a final rule requiring so-called navigatorsto have at least 30 hours of training in handling your private information. But the problem, say the AGs, is that DHHS isn’t requiring background or criminal checks on the people who handle your most private information. 

In fact, the standards for people who sell you health insurance are tougher than the security standards for these navigators, according to the complaint. The AGs point out that on a state level these health insurance sellers and brokers, unlike the "navigators" who handle the same private information, are subject to strict exam-based licensing. 

The DHHS response? The navigators have been trained enough and that’s that.

Call me crazy, but this strikes me as a cavalier response to the AGs.  I think the screws on our personal privacy are getting a little loose. Where I live, even Little League® coaches have to undergo criminal background checks. Teachers have to undergo three security clearances—a sex offender registry check, a state police background check and an FBI fingerprint check. All to pass out the white paste and crayons.

Why shouldn’t I know that that the person who is looking at my most intimate personal information—my health—isn’t a criminal who is going to sell my information? It’s pretty simple. I know that sometimes this privacy thing gets out of hand. It’s a relative thing. I don’t really care who knows what movie I took in last Friday night at the multiplex. But I might care a lot about who knows my diagnosis following a college weekend in Tijuana 20 years ago.

I think most people would agree that we need to update how we delivery and pay for healthcare. But the polls have consistently shown consumer opposition to the Affordable Care Act. Blowing off legal concerns about security is a bad way to convince already skeptical consumers that the ACA is will be a change for the better.

In the seemingly endless war over the Affordable Care Act, President Obama was able to claim a significant victory last Friday during what amounted to a campaign stop in California. The President chose the occasion to tout California as a model of the new healthcare law’s effectiveness.

The President has chosen to portray the continuing unpopularity of the ACA as the result of misunderstanding and misinformationon the part of the law’s detractors. And he may be right. Even for healthcare professionals this is a tough bill to figure out. So, when California’s healthcare exchange announced that the individual coverage plans to be offered next year by the exchange would be cheaper by up to 30% than comparable private sector plans today, it was time to celebrate.

But not so fast. The Lobster Shift wouldn’t be the Lobster Shift if it didn’t take a contrarian look at things (See our January 10, 2013 post). And if there is anything in this world that requires a skeptical look, it’s healthcare insurance.

Upon further review, it now looks like the optimistic projections of insurance offered at 2% to 29% below current markets was a case of California Dreamin’. Here’s why:

The California exchange regulators were comparing apples to oranges. They chose to compare the projected exchange rates to California’s current small-business market, where the heavy hand of state regulators has already distorted the market to the point where the exchange rates look good by comparison.

A more accurate comparisonwould have been comparing the exchange’s individual insurance plans with today’s individual plan market, which in California is more lightly regulated than the small-business market, and as a result functions fairly well.

If you compare apples to apples, or in this case, the current individual market to the individual plans to be offered next year through the state’s ACA exchange, there’s little to celebrate. According to the Wall Street Journal, there are five plans today that are 64% to 117% cheaper than what the state expects to market in the public exchange. That’s hardly worth gassing up Air Force One to fly across the country.

The narrative is now shifting. OK, say the regulators, we goofed. The individual market will be more expensive, but beneficiaries will be getting a lot more benefits. However, the cost-benefit of paying for birth control, fertility coverage and to have his children covered till they’re 26 may escape that 25-year old male whose focus may be restricted to hot cars and weekends at the beach.

The President is probably right about the misunderstanding and misinformation when it comes to the ACA. All the more reason when one side or the other claims victory in the healthcare battle to take a second look at the claim.